Effects of Glycemic Status and Antidiabetic Agents on the Recurrence of Chronic Rhinosinusitis with Nasal Polyps: A Multicenter Study.

Abstract

BackgroundAlthough several reports suggest that antidiabetic agents may exert anti-inflammatory effects, the influence of glycemic status and antidiabetic agents on chronic rhinosinusitis remains unexplored.ObjectiveThis study aimed to assess the impact of glycemic status and antidiabetic agents on postoperative recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP).MethodsWe conducted a retrospective review of records from six medical centers, including patients who underwent endoscopic sinus surgery for bilateral CRSwNP, with a minimum follow-up duration of 3 years. Patients were stratified into normoglycemic patients, dysglycemic patients without antidiabetic agent use, and dysglycemic patients receiving antidiabetic agents. Clinical characteristics were compared both across these groups and between patients with and without postoperative rhinosinusitis recurrence. Binary logistic regression analysis was used to identify independent predictors of recurrence and analyze medication-specific effects. Cumulative hazard of rhinosinusitis recurrence according to perioperative glycemic status and antidiabetic agent use were analyzed.ResultsA total of 503 patients were analyzed. During the postoperative follow-up period, rhinosinusitis recurrence occurred least frequently among dysglycemic patients receiving antidiabetic agents (P = .008). Antidiabetic agent users had a significantly reduced cumulative hazard of recurrence compared with nonusers (P < .001). Consistently, the proportion of antidiabetic agent users was significantly higher in the nonrecurrence group than in the recurrence group (P = 0.008). In contrast, perioperative fasting blood glucose and glycated hemoglobin levels were not significantly associated with postoperative recurrence. Binary logistic regression analysis identified younger age, absence of antidiabetic agent use, and poorer preoperative olfactory identification scores as independent predictors of recurrence.ConclusionPerioperative antidiabetic agent use was associated with a significantly reduced risk of postoperative recurrence in CRSwNP patients. The lack of significant association between glycemic status and recurrence further suggests that antidiabetic agents themselves, distinct from glycemic control, may exert a modulatory effect on the CRSwNP disease course.